Community Health Promotion -The ASHA Programme

Arwan Miki Pyrbot

DU2020BAS0069
Naina Borpatra Gohain-
DU2020BAS0039
Namrata Dutta-DU2020BAS0174
Department- Psychology

Introduction

ASHA or an Accredited Social Health Activist is a community worker employed by the

Ministry of Health and Family Welfare (MoHFW) as part of India's National Rural
Health Mission (NRHM). The mission began in 2005: full implementation was targeted
by 2012. The idea behind ASHA was to connect marginalized communities to the health
care system. The target was to have "ASHA in every village" in India. ASHA workers
are volunteers from within the community who are trained to provide information and aid
people in accessing the benefits of various healthcare schemes of the government. There
is around 10.4 lakh ASHA workers across the country. ASHA will be the first port of call
for any health related demands of deprived sections of the population, especially women
and children, who find it difficult to access health services. ASHA’s have her work
organized in following manner. She usually have a flexible work schedule and her work
load would be limited to putting in only about two-three hours per day, on about four
days per week, except during some mobilization events and training programmes.

SELECTION OF ASHA
The general norm is ‘One ASHA per 1000 population’. In tribal, hilly, desert areas the
norm could be relaxed to one ASHA per habitation, dependant on workload etc. The
States will also need to work out the district and block-wise coverage/phasing for
selection of ASHAs. It is envisaged that the selection and training process of ASHA will
be given due attention by the concerned State to ensure that at least 40 percent of the
envisaged. ASHAs in the State are selected and given induction training in the first year
as per the norms given in the guidelines. Rest of the ASHAs can subsequently be selected
and trained during second and third year.

Roles and Responsibilities

ASHA’s are the women trained to act as health educators and health promoters in their
communities. The Indian MoHFW describes them as follows:-

Their tasks includes;

 Motivating women to give birth in hospitals
 Bringing children to immunization clinics
 Encouraging family planning
 Treating basic illness and injuries with first aid
 Keeoing demographic records
 Improving village sanitation

ASHAs also serve as a ket communicationmechanism between the healthcare system and
rural populations.
An ASHA acts as a depot holder for essential provisions being made available to all
habitations like:

 Oral Rehydration Salts therapy

 Chloroquine
 Dispsal DeliveryKits
 Oral Pills
 Condoms

Their responsibilities can be classified into

1. Counselling
 Breast feeding
 Skilled birth attendance
 Preventioned diseases

2. Community sensitization
 Health
 Nutrition
 Related government programs

3. Provision of drugs
 Malaria
 Tuberculosis
 Diarrhoea

4. Escort
 Ante and Post natal care
 Institutional delivery
 Immunization
 Diabetes test

5. Diagninsis
 Malaria
 Pregnancy

6. Survey of health and related events

7. Others
 Community mobilization
 Health planning
 Participation in community health and allied activities
Role of ASHA workers in Assam:

As of today, 32546 huge and dedicated ASHA workforces serving the community with
all medical attention they require can be proudly displayed by the state of Assam. It
serves as an intermediary between the local community and health care providers. In
addition, if health problems occur, the Community considers that ASHAs are a first and
reliable port of call. The ASHAs are mainly involved in facilitating the delivery process
of a pregnant women right from the onset; they are keen to take care of the pregnant
women by ensuring the full antenatal care services, they are also concerned about the
completion of the immunization process of a child, they also have a strong desire to
facilitate the family planning services etc.

The support mechanism of the ASHA includes 2877 Supervisors. One Supervisor has
been supervising a group of ten to twelve asha workers. The District Community
Mobilizers (DCMs) at the district level supervise the Block Community Mobilizers
(BCMs), the ASHA Supervisors and the ASHA workers.

Contribution and Challenges of the ASHA Workers in Assam during the COVID-19
Crisis:
ASHA staff have been leading healthcare workers during the COVID-19 crisis. ASHA
staff are reportedly the main promoters of a community monitoring program set up to
monitor the health of people in Assam's 18,000 villages during the crisis. Each ASHA
employee's task is to visit each household in the affected area and collect information on
their current health status. Report personal travel history. To see if people are in home
quarantine. One of her key contributions is to raise awareness of door-to-door hygiene
maintenance within the home by demonstrating hand washing and steps to be taken
outside the home. At the height of the crisis, nearly 300 households were going door-to-
door every day. As ASHA staff work at the grassroots level, they had to work more than
12 hours a day during the COVID-19 pandemic. They have always played a very
important role in providing grassroots health awareness and facilities, but their workload
increased rapidly during the pandemic. But what is worrisome is that their salaries are
low and their achievements are largely unrecognized. The role of ASHA staff during this
pandemic is to raise public awareness about Covid-19, educate people about Covid-19
prevention and control measures, and help prevent the spread of this deadly disease. It
was to dispel myths about the virus. Their health should also be considered when
providing these services. A lot of work has to be done in the field to collect all the
necessary information, and in doing so you will be in contact with many people,
increasing your chances of contracting this contagious virus. Unfortunately they had to
consider discrimination in some places. The salaries they receive are paltry compared to
the services they provide and the stigma they face.

Scope

An ASHA worker will counsel women on birth preparedness, importance of safe

delivery, breast feeding and complementary feeding, immunization and contraception and
prevention of common infections including Reproductive Tract Infection/Sexually
Transmitted Infection and care of young children.
ASHA Benefit Package
ASHAs and ASHA Facilitators to be covered under Pradhan Mantri Suraksha
BimaYojana (Life Insurance). The eligibility criteria are 18-70 years. Cover is for one-
year period stretching from 1st June to 31st May and benefit is as under:–

 Pradhan Mantri Jeevan Jyoti Beema Yojana (PMJJBY) with a benefit Rs. 2.00
Lakh in case of death of the insured (annual premium contributed by GOI).
 Pradhan Mantri Suraksha Beema Yojana (PMSBY) with a benefit of Rs.2.00 lakh
for accidental death or permanent disability; Rs. 1.00 lakh for partial disability
(annual premium contributed by GOI).
 Pradhan Mantri Shram Yogi Maan Dhan (PM-SYM) with pension benefit of Rs.
3000 pm after age of 60 years (50% contribution of premium by GOI and 50% by
beneficiaries) is also available for ASHA workers.

Objectives of ASHA Workers:

1)To work for the alleviation of the poverty stricken and the grievances of the needy

2)helping poor people to get food by implementing food security programs

3)to provide skill development training, employment and income generation to the
unemployed

4)to provide education for children

5)to implement water and sanitation programs for the poor and need

6)to work for the protection of human rights and promotion of the oppressed class

7)to protect and develop forestry, environment, natural and agricultural resources
8)to implement community health programmes in rural, tribal and slum areas

9)to create awareness among the people about AIDS/HIV and preventative methods

10)to implement natural disaster management programs

Achievement of ASHA workers:-

They create awareness about health determinants by providing information to the people
about nutrition, basic sanitation & hygienic practices, healthy living and working
conditions, etc.
ASHA counsels women on birth preparedness, safe delivery’s importance, breastfeeding,
contraception, immunization, child care and prevention of Reproductive Tract
Infection/Sexually Transmitted Infection (RTIs/STIs).
ASHA provides primary medical care for minor disorders like fever, diarrhoea and minor
injuries.
They also keep the sub-centres/primary health centres informed about births and deaths in
their village and any disease outbreaks/unusual health concerns in the community.

Description of Our ASHA worker

Our Asha workers name is Sobita Kalengpi . She was mainly from Karbi Anglong’s one
of the remote areas. She joined as a asha worker in the year 2012 .Then from 2013 she
started working and got posted in Sonapur (Tepesia) as her field area. She’s in her 40s
and worked for 10 years . She had spread awareness in many areas and people are equally
cooperating with her rather than the rural area where she lived before. She lives in
Guwahati now and daily travels to sonapur to do her duty .

The Interview

Q1. What do they do ?

Their main work is related to pregnant women. The couples who have married illegally
and now are pregnant. Their work is to look after them legally. If the family wants the
baby then they go and check if the girl is in her legal and healthy age during her
pregnancy (like 15-19 they fall under high risk). So they advise and encourage them to
use contraceptics. Nowadays the asha workers prefer them to use injectable
contraceptics, oral pills, condoms and IUCD(Intra Uterine contraceptives Device). They
advice them to wait atleast three years after marriage before planning a baby but
ultimately they cannot force them, its their own decision.

Q. Any targets fulfilled or their success stories?

They’ve actually fulfilled the polio immunization target. All adults should make sure that
they have been vaccinated against polio. Adults receiving the polio vaccine for the first
time should have a course of three injections with an interval of four weeks between the
doses. If you have not received at least three doses of polio vaccine .Children usually get
the inactivated poliovirus vaccine (IPV) at ages 2 months, 4 months, 6–18 months, and
4–6 years. The asha workers go to each and every house in the areas that they are allotted
and give immunization shots to the child . If the immunization process is not done in a
proper way, then they have to be answerable to their higher authority which later in result
they have to again start the process from the first. Till now what they had done and
completed , they consider it as a success for them.

Q. What are some of the challenges that they have faced in relation to their work?

Inadequate Pay and Job Insecurity: Among the 3As in the rural areas (Anganwadi
Workers (AWW), Auxiliary Nurse Midwife (ANM) and ASHA), the ASHAs are the only
ones who do not have a fixed salary. They also do not have opportunities for career
progression.
These issues have resulted in dissatisfaction, regular agitations and protests by ASHAs in
many States of India. Moreover, even the workload for the ASHAs is not less; they have
to work from morning to night without any place for rest.
Social Stigma and Humiliation: ASHA workers often experience stigma not only in
public space but also in the private sphere; there is often pressure from their to
discontinue their work due to very low honorarium. Even from the patients’ families,
they often suffer allegations of not doing their job properly.An even more disheartening
fact is that ASHA workers have to experience sexual harassment during field visits.
Unavailability of Facilities: ASHAs reported facing challenges in ensuring access to
health services during and immediately after outbreaks of conflict. They experienced
difficulty in arranging transport and breakdown of services at remote health
facilities.Many ASHAs are working in fragile and conflict-affected settings such as
Kokrajhar and Karbi Anglong districts of Assam state. No efforts have yet been made to
understand the challenges and vulnerabilities of these volunteers working under such
conditions.

WHAT WE HAVE LEARNED FROM THE ASHA WORKERS (THE OUTCOME

OF INTERVIEW)
We have learned a lot from this interview like how the workers spread awareness, how
they advice the people , how they manage to complete their task in the limited period of
time. They also solve the family problem that few women faces though its not really their
job but they are open for any help if needed. They face a lot of challenges from planning
a certain program to actually implementing it on ground. People still follow traditional
ways of child birth and contraceptives making a door to door visit and making the people
understand is not a easy job but still they do it with a smile on their face. It teaches us no
matter what if we stand strong with a cause or a believe to bring change in society,
anything is possible. We just have to trust the process.
Photographic Evidence